title: Chemotherapy use for hormone receptor-positive, lymph node-negative breast cancer.
abstract: OBJECTIVE
  To describe the frequency of chemotherapy use for hormone receptor (HR)-positive, lymph node (LN)-negative breast cancer from 1997 to 2004 at eight National Comprehensive Cancer Network institutions, to explore whether chemotherapy use varied over time and between institutions, and to identify factors associated with the decision to forego chemotherapy.
  
  
  METHODS
  Among women younger than age 70 years with HR-positive, LN-negative breast cancer measuring more than 1 cm, we analyzed the frequency of chemotherapy use on a yearly basis. A multivariable logistic regression model assessed the relationship between receipt of chemotherapy and year of diagnosis, institution, tumor features, and patient characteristics. Interaction terms were added to the model, and stratified analyses were conducted to further explore the determinants of chemotherapy use.
  
  
  RESULTS
  Fifty-five percent of 3,190 women received chemotherapy. Chemotherapy use was less common for patients with 1.1- to 2-cm tumors than for patients tumors greater 2 cm (47% v 87%, respectively; P < .01) and for women age 60 to 69 years versus women younger than age 50 years (24% v 76%, respectively; P < .01). On multivariable analysis, predictors independently associated with receiving chemotherapy included larger tumor size, higher grade, human epidermal growth factor receptor 2 overexpression, younger age, and institution (P < .01 for all). Institutions exhibited dramatically different rates of chemotherapy use (from 46% to 65%) and patterns of change in chemotherapy use over time (from a 79% relative increase to a 22% relative decrease).
  
  
  CONCLUSIONS
  Although institutions seemed to agree that not all women with HR-positive, LN-negative breast cancer need chemotherapy, there did not seem to be consensus regarding which women should get chemotherapy. Only prospective randomized controlled trials will conclusively establish which subtypes of HR-positive, LN-negative breast cancer benefit from chemotherapy.
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, 44 Binney St, Boston, MA 02115, USA. michael_hassett@dfci.harvard.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Hassett
authors.forename: Melissa E
authors.initials: ME
authors.lastname: Hughes
authors.forename: Joyce C
authors.initials: JC
authors.lastname: Niland
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Edge
authors.forename: Richard L
authors.initials: RL
authors.lastname: Theriault
authors.forename: Yu-Ning
authors.initials: YN
authors.lastname: Wong
authors.forename: John
authors.initials: J
authors.lastname: Wilson
authors.forename: W Bradford
authors.initials: WB
authors.lastname: Carter
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Blayney
authors.forename: Jane C
authors.initials: JC
authors.lastname: Weeks
mesh_terms: D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008495:Medical Oncology / Q000379:methods; D008593:Menopause; D008875:Middle Aged; D016017:Odds Ratio; D011960:Receptors, Estrogen / Q000096:biosynthesis* / Q000378:metabolism; D012044:Regression Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D011960:Receptors, Estrogen